The initial guidelines to what determines brain death were created in 1995. Since then hospitals have individually altered the practice to become what they thought were more efficient and accurate. After looking at what hospitals have been doing in the past fifteen years it was evident than a revised version of the criteria that must be strictly adhered to was needed. It was alarming what some hospitals were and were not deeming brain-death. Although none of the exact methods were released for legal reasons they were described in an article in the USA Today and downright wrong.
Physicians wanted answers:
There were five questions that physicians wanted to answer to assess whether new guidelines were necessary.
1.) Did any patient declared brain dead according to the previous set guidelines ever recover brain function?
Any such case has never been reported.
2.) How long should a patient be monitored before the final decision is made?
The amount of time a patient should be monitored is different for each individual case. There can be no set minimal or maximum time.
3.) Do patients said to be brain-dead still move involuntarily?
Yes. Some individuals will have involuntary movements. These are false signs of brain activity.
4.) Is apnea testing a good indicator?
Apnea testing is where oxygen is pushed through the blood to see if a patients body will take over functions such as breathing and heartbeat. Brain death is more than loss of involuntary movements so it’s an indicator but not the deciding factor by any means.
5.) Are there any new tests to more accurately determine brain death?
None that are widely accepted enough by physicians to be added to the current brain death guidelines and as such new ones will be created.
The Old Guidelines
There was a 10-step checklist, if you can call it that, approach for determining brain death.
First the doctor would determine whether the causes of the coma could be reversed and the family must be notified of the case. After that there would be a first assessment of the brain stem with a reflex test. Each hospital then had a defined waiting period in which the patient must be observed. There was a second clinical brain stem test of reflexes, the apnea test, and confirmation tests. Finally the brain death would be certified and the life support would be removed ending what was left of the individual’s life.
What’s Different Between the Old and New Guidelines
One of the most notable differences in the new guidelines is that now just one exam may be sufficient to determine brain death. The differences between the two sets of criteria is that the second is much more thorough. It leaves almost no room for individual interpretation. Will a matter as serious as brain death physicians felt that a uniform set of guidelines to be followed throughout all hospitals was the only way to ensure no patient ever gets wrongfully diagnosed.
A full set of the guidelines can be viewed in the June 8, 2010 magazine Neurology. A set of the standards prior to the changed can be found here.
By comparing the two it is apparent that the only differences are in the details. While the first version can fit on a single-sheet checklist, the new and improved version is more like a manual. But when dealing with something as devastating as brain death, ease of diagnosis isn’t a top priority.